The Great Mental Models Volumes One and Two are out.
Learn more about the project here.
This guide explores everything you need to know about mental models. By the time you’re done, you’ll think better, make fewer mistakes, and get better results.
Let’s explore the following:
Mental models are how we understand the world. Not only do they shape what we think and how we understand but they shape the connections and opportunities that we see. Mental models are how we simplify complexity, why we consider some things more relevant than others, and how we reason.
A mental model is simply a representation of how something works. We cannot keep all of the details of the world in our brains, so we use models to simplify the complex into understandable and organizable chunks.
The quality of our thinking is proportional to the models in our head and their usefulness in the situation at hand. The more models you have—the bigger your toolbox—the more likely you are to have the right models to see reality. It turns out that when it comes to improving your ability to make decisions variety matters.
Most of us, however, are specialists. Instead of a latticework of mental models, we have a few from our discipline. Each specialist sees something different. By default, a typical Engineer will think in systems. A psychologist will think in terms of incentives. A biologist will think in terms of evolution. By putting these disciplines together in our head, we can walk around a problem in a three dimensional way. If we’re only looking at the problem one way, we’ve got a blind spot. And blind spots can kill you.
Here’s another way to think about it. When a botanist looks at a forest they may focus on the ecosystem, an environmentalist sees the impact of climate change, a forestry engineer the state of the tree growth, a business person the value of the land. None are wrong, but neither are any of them able to describe the full scope of the forest. Sharing knowledge, or learning the basics of the other disciplines, would lead to a more well-rounded understanding that would allow for better initial decisions about managing the forest.
In a famous speech in the 1990s, Charlie Munger summed up the approach to practical wisdom through understanding mental models by saying: “Well, the first rule is that you can’t really know anything if you just remember isolated facts and try and bang ’em back. If the facts don’t hang together on a latticework of theory, you don’t have them in a usable form. You’ve got to have models in your head. And you’ve got to array your experience both vicarious and direct on this latticework of models. You may have noticed students who just try to remember and pound back what is remembered. Well, they fail in school and in life. You’ve got to hang experience on a latticework of models in your head.”
A Latticework of Mental Models
To help you build your latticework of mental models so you can make better decisions, we’ve collected and summarized the ones we’ve found the most useful.
And remember: Building your latticework is a lifelong project. Stick with it, and you’ll find that your ability to understand reality, make consistently good decisions, and help those you love will always be improving.
General Thinking Concepts
1. The Map is not the Territory
The map of reality is not reality. Even the best maps are imperfect. That’s because they are reductions of what they represent. If a map were to represent the territory with perfect fidelity, it would no longer be a reduction and thus would no longer be useful to us. A map can also be a snapshot of a point in time, representing something that no longer exists. This is important to keep in mind as we think through problems and make better decisions.
2. Circle of Competence
When ego and not competence drives what we undertake, we have blind spots. If you know what you understand, you know where you have an edge over others. When you are honest about where your knowledge is lacking you know where you are vulnerable and where you can improve. Understanding your circle of competence improves decision making and outcomes.
3. First Principles Thinking
First principles thinking is one of the best ways to reverse-engineer complicated situations and unleash creative possibility. Sometimes called reasoning from first principles, it’s a tool to help clarify complicated problems by separating the underlying ideas or facts from any assumptions based on them. What remains are the essentials. If you know the first principles of something, you can build the rest of your knowledge around them to produce something new.
4. Thought Experiment
Thought experiments can be defined as “devices of the imagination used to investigate the nature of things.” Many disciplines, such as philosophy and physics, make use of thought experiments to examine what can be known. In doing so, they can open up new avenues for inquiry and exploration. Thought experiments are powerful because they help us learn from our mistakes and avoid future ones. They let us take on the impossible, evaluate the potential consequences of our actions, and re-examine history to make better decisions. They can help us both figure out what we really want, and the best way to get there.
5. Second-Order Thinking
Almost everyone can anticipate the immediate results of their actions. This type of first-order thinking is easy and safe but it’s also a way to ensure you get the same results that everyone else gets. Second-order thinking is thinking farther ahead and thinking holistically. It requires us to not only consider our actions and their immediate consequences, but the subsequent effects of those actions as well. Failing to consider the second and third order effects can unleash disaster.
6. Probabilistic Thinking
Probabilistic thinking is essentially trying to estimate, using some tools of math and logic, the likelihood of any specific outcome coming to pass. It is one of the best tools we have to improve the accuracy of our decisions. In a world where each moment is determined by an infinitely complex set of factors, probabilistic thinking helps us identify the most likely outcomes. When we know these our decisions can be more precise and effective.
This includes Fat-Tailed Processes
A process can often look like a normal distribution but have a large “tail” – meaning that seemingly outlier events are far more likely than they are in an actual normal distribution. A strategy or process may be far more risky than a normal distribution is capable of describing if the fat tail is on the negative side, or far more profitable if the fat tail is on the positive side. Much of the human social world is said to be fat-tailed rather than normally distributed.
and Bayesian Updating
The Bayesian method is a method of thought (named for Thomas Bayes) whereby one takes into account all prior relevant probabilities and then incrementally updates them as newer information arrives. This method is especially productive given the fundamentally non-deterministic world we experience: We must use prior odds and new information in combination to arrive at our best decisions. This is not necessarily our intuitive decision-making engine.
Inversion is a powerful tool to improve your thinking because it helps you identify and remove obstacles to success. The root of inversion is “invert,” which means to upend or turn upside down. As a thinking tool it means approaching a situation from the opposite end of the natural starting point. Most of us tend to think one way about a problem: forward. Inversion allows us to flip the problem around and think backward. Sometimes it’s good to start at the beginning, but it can be more useful to start at the end.
8. Occam’s Razor
Simpler explanations are more likely to be true than complicated ones. This is the essence of Occam’s Razor, a classic principle of logic and problem-solving. Instead of wasting your time trying to disprove complex scenarios, you can make decisions more confidently by basing them on the explanation that has the fewest moving parts.
9. Hanlon’s Razor
Hard to trace in its origin, Hanlon’s Razor states that we should not attribute to malice that which is more easily explained by stupidity. In a complex world, using this model helps us avoid paranoia and ideology. By not generally assuming that bad results are the fault of a bad actor, we look for options instead of missing opportunities. This model reminds us that people do make mistakes. It demands that we ask if there is another reasonable explanation for the events that have occurred. The explanation most likely to be right is the one that contains the least amount of intent.
Relativity has been used in several contexts in the world of physics, but the important aspect to study is the idea that an observer cannot truly understand a system of which he himself is a part. For example, a man inside an airplane does not feel like he is experiencing movement, but an outside observer can see that movement is occurring. This form of relativity tends to affect social systems in a similar way.
If I push on a wall, physics tells me that the wall pushes back with equivalent force. In a biological system, if one individual acts on another, the action will tend to be reciprocated in kind. And of course, human beings act with intense reciprocity demonstrated as well.
The laws of thermodynamics describe energy in a closed system. The laws cannot be escaped and underlie the physical world. They describe a world in which useful energy is constantly being lost, and energy cannot be created or destroyed. Applying their lessons to the social world can be a profitable enterprise.
An object in motion with a certain vector wants to continue moving in that direction unless acted upon. This is a fundamental physical principle of motion; however, individuals, systems, and organizations display the same effect. It allows them to minimize the use of energy, but can cause them to be destroyed or eroded.
5. Friction and Viscosity
Both friction and viscosity describe the difficulty of movement. Friction is a force that opposes the movement of objects that are in contact with each other, and viscosity measures how hard it is for one fluid to slide over another. Higher viscosity leads to higher resistance. These concepts teach us a lot about how our environment can impede our movement.
Velocity is not equivalent to speed; the two are sometimes confused. Velocity is speed plus vector: how fast something gets somewhere. An object that moves two steps forward and then two steps back has moved at a certain speed but shows no velocity. The addition of the vector, that critical distinction, is what we should consider in practical life.
Most of the engineering marvels of the world were accomplished with applied leverage. As famously stated by Archimedes, “Give me a lever long enough and I shall move the world.” With a small amount of input force, we can make a great output force through leverage. Understanding where we can apply this model to the human world can be a source of great success.
8. Activation Energy
A fire is not much more than a combination of carbon and oxygen, but the forests and coal mines of the world are not combusting at will because such a chemical reaction requires the input of a critical level of “activation energy” in order to get a reaction started. Two combustible elements alone are not enough.
A catalyst either kick-starts or maintains a chemical reaction, but isn’t itself a reactant. The reaction may slow or stop without the addition of catalysts. Social systems, of course, take on many similar traits, and we can view catalysts in a similar light.
When we combine various elements, we create new substances. This is no great surprise, but what can be surprising in the alloying process is that 2+2 can equal not 4 but 6 – the alloy can be far stronger than the simple addition of the underlying elements would lead us to believe. This process leads us to engineer great physical objects, but we understand many intangibles in the same way; a combination of the right elements in social systems or even individuals can create a 2+2=6 effect similar to alloying.
1. Evolution Part One: Natural Selection and Extinction
Evolution by natural selection was once called “the greatest idea anyone ever had.” In the 19th century, Charles Darwin and Alfred Russel Wallace simultaneously realized that species evolve through random mutation and differential survival rates. If we call human intervention in animal-breeding an example of “artificial selection,” we can call Mother Nature deciding the success or failure of a particular mutation “natural selection.” Those best suited for survival tend to be preserved. But of course, conditions change.
2. Evolution Part Two: Adaptation and The Red Queen Effect
Species tend to adapt to their surroundings in order to survive, given the combination of their genetics and their environment – an always-unavoidable combination. However, adaptations made in an individual’s lifetime are not passed down genetically, as was once thought: Populations of species adapt through the process of evolution by natural selection, as the most-fit examples of the species replicate at an above-average rate.
The evolution-by-natural-selection model leads to something of an arms race among species competing for limited resources. When one species evolves an advantageous adaptation, a competing species must respond in kind or fail as a species. Standing still can mean falling behind. This arms race is called the Red Queen Effect for the character in Alice in Wonderland who said, “Now, here, you see, it takes all the running you can do, to keep in the same place.”
An ecosystem describes any group of organisms coexisting with the natural world. Most ecosystems show diverse forms of life taking on different approaches to survival, with such pressures leading to varying behavior. Social systems can be seen in the same light as the physical ecosystems and many of the same conclusions can be made.
Most organisms find a niche: a method of competing and behaving for survival. Usually, a species will select a niche for which it is best adapted. The danger arises when multiple species begin competing for the same niche, which can cause an extinction – there can be only so many species doing the same thing before limited resources give out.
Without a strong self-preservation instinct in an organism’s DNA, it would tend to disappear over time, thus eliminating that DNA. While cooperation is another important model, the self-preservation instinct is strong in all organisms and can cause violent, erratic, and/or destructive behavior for those around them.
A fundamental building block of diverse biological life is high-fidelity replication. The fundamental unit of replication seems to be the DNA molecule, which provides a blueprint for the offspring to be built from physical building blocks. There are a variety of replication methods, but most can be lumped into sexual and asexual.
Competition tends to describe most biological systems, but cooperation at various levels is just as important a dynamic. In fact, the cooperation of a bacterium and a simple cell probably created the first complex cell and all of the life we see around us. Without cooperation, no group survives, and the cooperation of groups gives rise to even more complex versions of organization. Cooperation and competition tend to coexist at multiple levels.
The Prisoner’s Dilemma is a famous application of game theory in which two prisoners are both better off cooperating with each other, but if one of them cheats, the other is better off cheating. Thus the dilemma. This model shows up in economic life, in war, and in many other areas of practical human life. Though the prisoner’s dilemma theoretically leads to a poor result, in the real world, cooperation is nearly always possible and must be explored.
8. Hierarchical Organization
Most complex biological organisms have an innate feel for how they should organize. While not all of them end up in hierarchical structures, many do, especially in the animal kingdom. Human beings like to think they are outside of this, but they feel the hierarchical instinct as strongly as any other organism. This includes the Stanford Prison Experiment and Milgram Experiments, which demonstrated what humans learned practically many years before: the human bias towards being influenced by authority. In a dominance hierarchy such as ours, we tend to look to the leader for guidance on behavior, especially in situations of stress or uncertainty. Thus, authority figures have a responsibility to act well, whether they like it or not.
All creatures respond to incentives to keep themselves alive. This is the basic insight of biology. Constant incentives will tend to cause a biological entity to have constant behavior, to an extent. Humans are included and are particularly great examples of the incentive-driven nature of biology; however, humans are complicated in that their incentives can be hidden or intangible. The rule of life is to repeat what works and has been rewarded.
10. Tendency to Minimize Energy Output (Mental & Physical)
In a physical world governed by thermodynamics and competition for limited energy and resources, any biological organism that was wasteful with energy would be at a severe disadvantage for survival. Thus, we see in most instances that behavior is governed by a tendency to minimize energy usage when at all possible.
1. Feedback Loops
All complex systems are subject to positive and negative feedback loops whereby A causes B, which in turn influences A (and C), and so on – with higher-order effects frequently resulting from continual movement of the loop. In a homeostatic system, a change in A is often brought back into line by an opposite change in B to maintain the balance of the system, as with the temperature of the human body or the behavior of an organizational culture. Automatic feedback loops maintain a “static” environment unless and until an outside force changes the loop. A “runaway feedback loop” describes a situation in which the output of a reaction becomes its own catalyst (auto-catalysis).
2. Bottlenecks and Constraints
A bottleneck describes the place at which a flow (of a tangible or intangible) is stopped, thus constraining it back from continuous movement. As with a clogged artery or a blocked drain, a bottleneck in production of any good or service can be small but have a disproportionate impact if it is in the critical path. However, bottlenecks and constraints can also be a source of inspiration as they force us reconsider if there are alternate pathways to success.
3. Homeostasis and Equilibrium
Homeostasis is the process through which systems self-regulate to maintain an equilibrium state that enables them to function in a changing environment. Most of the time, they over or undershoot it by a little and must keep adjusting. Like a pilot flying a plane, the system is off course more often than on course. Everything within a homeostatic system contributes to keeping it within a range of equilibrium, so it is important to understand the limits of the range.
One of the most important principles of systems is that they are sensitive to scale. Properties (or behaviors) tend to change when you scale them up or down. In studying complex systems, we must always be roughly quantifying – in orders of magnitude, at least – the scale at which we are observing, analyzing, or predicting the system.
5. Law of Diminishing Returns
Related to scale, most important real-world results are subject to an eventual decrease of incremental value. A good example would be a poor family: Give them enough money to thrive, and they are no longer poor. But after a certain point, additional money will not improve their lot; there is a clear diminishing return of additional dollars at some roughly quantifiable point. Often, the law of diminishing returns veers into negative territory – i.e., receiving too much money could destroy the poor family.
Insurance companies and subscription services are well aware of the concept of churn – every year, a certain number of customers are lost and must be replaced. Standing still is the equivalent of losing, as seen in the model called the “Red Queen Effect.” Churn is present in many business and human systems: A constant figure is periodically lost and must be replaced before any new figures are added over the top.
7. Preferential Attachment (Cumulative Advantage)
A preferential attachment situation occurs when the current leader is given more of the reward than the laggards, thereby tending to preserve or enhance the status of the leader. A strong network effect is a good example of preferential attachment; a market with 10x more buyers and sellers than the next largest market will tend to have a preferential attachment dynamic.
We find that in most systems there are irreducible quantitative properties, such as complexity, minimums, time, and length. Below the irreducible level, the desired result simply does not occur. One cannot get several women pregnant to reduce the amount of time needed to have one child, and one cannot reduce a successfully built automobile to a single part. These results are, to a defined point, irreducible.
9. Margin of Safety and Backup Systems
Similarly, engineers have also developed the habit of adding a margin for error into all calculations. In an unknown world, driving a 9,500-pound bus over a bridge built to hold precisely 9,600 pounds is rarely seen as intelligent. Thus, on the whole, few modern bridges ever fail. In practical life outside of physical engineering, we can often profitably give ourselves margins as robust as the bridge system.
A critical model of the engineering profession is that of backup systems. A good engineer never assumes the perfect reliability of the components of the system. He or she builds in redundancy to protect the integrity of the total system. Without the application of this robustness principle, tangible and intangible systems tend to fail over time.
While hard to precisely define, an algorithm is generally an automated set of rules or a “blueprint” leading a series of steps or actions resulting in a desired outcome, and often stated in the form of a series of “If → Then” statements. Algorithms are best known for their use in modern computing, but are a feature of biological life as well. For example, human DNA contains an algorithm for building a human being.
A system becomes critical when it is about to jump discretely from one phase to another. The marginal utility of the last unit before the phase change is wildly higher than any unit before it. A frequently cited example is water turning from a liquid to a vapor when heated to a specific temperature. “Critical mass” refers to the mass needed to have the critical event occur, most commonly in a nuclear system.
Higher-level behavior tends to emerge from the interaction of lower-order components. The result is frequently not linear – not a matter of simple addition – but rather non-linear, or exponential. An important resulting property of emergent behavior is that it cannot be predicted from simply studying the component parts.
The normal distribution is a statistical process that leads to the well-known graphical representation of a bell curve, with a meaningful central “average” and increasingly rare standard deviations from that average when correctly sampled. (The so-called “central limit” theorem.) Well-known examples include human height and weight, but it’s just as important to note that many common processes, especially in non-tangible systems like social systems, do not follow the normal distribution.
It’s been said that Einstein called compounding a wonder of the world. He probably didn’t, but it is a wonder. Compounding is the process by which we add interest to a fixed sum, which then earns interest on the previous sum and the newly added interest, and then earns interest on that amount, and so on ad infinitum. It is an exponential effect, rather than a linear, or additive, effect. Money is not the only thing that compounds; ideas and relationships do as well. In tangible realms, compounding is always subject to physical limits and diminishing returns; intangibles can compound more freely. Compounding also leads to the time value of money, which underlies all of modern finance.
3. Law of Large Numbers
One of the fundamental underlying assumptions of probability is that as more instances of an event occur, the actual results will converge on the expected ones. For example, if I know that the average man is 5 feet 10 inches tall, I am far more likely to get an average of 5′10″ by selecting 500 men at random than 5 men at random. The opposite of this model is the law of small numbers, which states that small samples can and should be looked at with great skepticism.
4. Multiplying by Zero
Any reasonably educated person knows that any number multiplied by zero, no matter how large the number, is still zero. This is true in human systems as well as mathematical ones. In some systems, a failure in one area can negate great effort in all other areas. As simple multiplication would show, fixing the “zero” often has a much greater effect than does trying to enlarge the other areas.
5. Algebraic Equivalence
The introduction of algebra allowed us to demonstrate mathematically and abstractly that two seemingly different things could be the same. By manipulating symbols, we can demonstrate equivalence or inequivalence, the use of which led humanity to untold engineering and technical abilities. Knowing at least the basics of algebra can allow us to understand a variety of important results.
Though the human brain has trouble comprehending it, much of the world is composed of random, non-sequential, non-ordered events. We are “fooled” by random effects when we attribute causality to things that are actually outside of our control. If we don’t course-correct for this fooled-by-randomness effect – our faulty sense of pattern-seeking – we will tend to see things as being more predictable than they are and act accordingly.
7. Regression to the Mean
In a normally distributed system, long deviations from the average will tend to return to that average with an increasing number of observations: the so-called Law of Large Numbers. We are often fooled by regression to the mean, as with a sick patient improving spontaneously around the same time they begin taking an herbal remedy, or a poorly performing sports team going on a winning streak. We must be careful not to confuse statistically likely events with causal ones.
8. Surface Area
The surface area of a three dimensional object is the amount of space on the outside of it. Thus, the more surface area you have, the more contact you have with your environment. Sometimes a high surface area is desirable: Our lungs and intestines have a huge surface area to increase the absorption of oxygen and nutrients. Other times we want to reduce our exposure, such as limiting our internet exposure to reduce the attack surface.
9. Global and Local Maxima
The maxima and minima of a mathematical function are the largest and smallest values over its domain. Although there is one maximum value, the global maximum, there can be smaller peaks of value in a given range, the local maxima. Global and local maxima help us identify peaks, and if there is still potential to go higher or lower. It also reminds us that sometimes we have to go down to go back up.
1. Opportunity Costs
Doing one thing means not being able to do another. We live in a world of trade-offs, and the concept of opportunity cost rules all. Most aptly summarized as “there is no such thing as a free lunch.”
2. Creative Destruction
Coined by economist Joseph Schumpeter, the term “creative destruction” describes the capitalistic process at work in a functioning free-market system. Motivated by personal incentives (including but not limited to financial profit), entrepreneurs will push to best one another in a never-ending game of creative one-upmanship, in the process destroying old ideas and replacing them with newer technology. Beware getting left behind.
3. Comparative Advantage
The Scottish economist David Ricardo had an unusual and non-intuitive insight: Two individuals, firms, or countries could benefit from trading with one another even if one of them was better at everything. Comparative advantage is best seen as an applied opportunity cost: If it has the opportunity to trade, an entity gives up free gains in productivity by not focusing on what it does best.
4. Specialization (Pin Factory)
Another Scottish economist, Adam Smith, highlighted the advantages gained in a free-market system by specialization. Rather than having a group of workers each producing an entire item from start to finish, Smith explained that it’s usually far more productive to have each of them specialize in one aspect of production. He also cautioned, however, that each worker might not enjoy such a life; this is a trade-off of the specialization model.
5. Seizing the Middle
In chess, the winning strategy is usually to seize control of the middle of the board, so as to maximize the potential moves that can be made and control the movement of the maximal number of pieces. The same strategy works profitably in business, as can be demonstrated by John D. Rockefeller’s control of the refinery business in the early days of the oil trade and Microsoft’s control of the operating system in the early days of the software trade.
6. Trademarks, Patents, and Copyrights
These three concepts, along with other related ones, protect the creative work produced by enterprising individuals, thus creating additional incentives for creativity and promoting the creative-destruction model of capitalism. Without these protections, information and creative workers have no defense against their work being freely distributed.
7. Double-Entry Bookkeeping
One of the marvels of modern capitalism has been the bookkeeping system introduced in Genoa in the 14th century. The double-entry system requires that every entry, such as income, also be entered into another corresponding account. Correct double-entry bookkeeping acts as a check on potential accounting errors and allows for accurate records and thus, more accurate behavior by the owner of a firm.
8. Utility (Marginal, Diminishing, Increasing)
The usefulness of additional units of any good tends to vary with scale. Marginal utility allows us to understand the value of one additional unit, and in most practical areas of life, that utility diminishes at some point. On the other hand, in some cases, additional units are subject to a “critical point” where the utility function jumps discretely up or down. As an example, giving water to a thirsty man has diminishing marginal utility with each additional unit, and can eventually kill him with enough units.
Often ignored in mainstream economics, the concept of bribery is central to human systems: Given the chance, it is often easier to pay a certain agent to look the other way than to follow the rules. The enforcer of the rules is then neutralized. This principle/agent problem can be seen as a form of arbitrage.
Given two markets selling an identical good, an arbitrage exists if the good can profitably be bought in one market and sold at a profit in the other. This model is simple on its face, but can present itself in disguised forms: The only gas station in a 50-mile radius is also an arbitrage as it can buy gasoline and sell it at the desired profit (temporarily) without interference. Nearly all arbitrage situations eventually disappear as they are discovered and exploited.
11. Supply and Demand
The basic equation of biological and economic life is one of limited supply of necessary goods and competition for those goods. Just as biological entities compete for limited usable energy, so too do economic entities compete for limited customer wealth and limited demand for their products. The point at which supply and demand for a given good are equal is called an equilibrium; however, in practical life, equilibrium points tend to be dynamic and changing, never static.
Game theory describes situations of conflict, limited resources, and competition. Given a certain situation and a limited amount of resources and time, what decisions are competitors likely to make, and which should they make? One important note is that traditional game theory may describe humans as more rational than they really are. Game theory is theory, after all.
13. Mr. Market
Mr. Market was introduced by the investor Benjamin Graham in his seminal book The Intelligent Investor to represent the vicissitudes of the financial markets. As Graham explains, the markets are a bit like a moody neighbor, sometimes waking up happy and sometimes waking up sad – your job as an investor is to take advantage of him in his bad moods and sell to him in his good moods. This attitude is contrasted to an efficient-market hypothesis in which Mr. Market always wakes up in the middle of the bed, never feeling overly strong in either direction.
1. Seeing the Front
One of the most valuable military tactics is the habit of “personally seeing the front” before making decisions – not always relying on advisors, maps, and reports, all of which can be either faulty or biased. The Map/Territory model illustrates the problem with not seeing the front, as does the incentive model. Leaders of any organization can generally benefit from seeing the front, as not only does it provide firsthand information, but it also tends to improve the quality of secondhand information.
2. Asymmetric Warfare
The asymmetry model leads to an application in warfare whereby one side seemingly “plays by different rules” than the other side due to circumstance. Generally, this model is applied by an insurgency with limited resources. Unable to out-muscle their opponents, asymmetric fighters use other tactics, as with terrorism creating fear that’s disproportionate to their actual destructive ability.
3. Two-Front War
The Second World War was a good example of a two-front war. Once Russia and Germany became enemies, Germany was forced to split its troops and send them to separate fronts, weakening their impact on either front. In practical life, opening a two-front war can often be a useful tactic, as can solving a two-front war or avoiding one, as in the example of an organization tamping down internal discord to focus on its competitors.
Though asymmetric insurgent warfare can be extremely effective, over time competitors have also developed counterinsurgency strategies. Recently and famously, General David Petraeus of the United States led the development of counterinsurgency plans that involved no additional force but substantial additional gains. Tit-for-tat warfare or competition will often lead to a feedback loop that demands insurgency and counterinsurgency.
5. Mutually Assured Destruction
Somewhat paradoxically, the stronger two opponents become, the less likely they may be to destroy one another. This process of mutually assured destruction occurs not just in warfare, as with the development of global nuclear warheads, but also in business, as with the avoidance of destructive price wars between competitors. However, in a fat-tailed world, it is also possible that mutually assured destruction scenarios simply make destruction more severe in the event of a mistake (pushing destruction into the “tails” of the distribution).
Fundamentally, the modern world operates on trust. Familial trust is generally a given (otherwise we’d have a hell of a time surviving), but we also choose to trust chefs, clerks, drivers, factory workers, executives, and many others. A trusting system is one that tends to work most efficiently; the rewards of trust are extremely high.
2. Bias from Incentives
Highly responsive to incentives, humans have perhaps the most varied and hardest to understand set of incentives in the animal kingdom. This causes us to distort our thinking when it is in our own interest to do so. A wonderful example is a salesman truly believing that his product will improve the lives of its users. It’s not merely convenient that he sells the product; the fact of his selling the product causes a very real bias in his own thinking.
3. Pavlovian Association
Ivan Pavlov very effectively demonstrated that animals can respond not just to direct incentives but also to associated objects; remember the famous dogs salivating at the ring of a bell. Human beings are much the same and can feel positive and negative emotion towards intangible objects, with the emotion coming from past associations rather than direct effects.
4. Tendency to Feel Envy & Jealousy
Humans have a tendency to feel envious of those receiving more than they are, and a desire “get what is theirs” in due course. The tendency towards envy is strong enough to drive otherwise irrational behavior, but is as old as humanity itself. Any system ignorant of envy effects will tend to self-immolate over time.
5. Tendency to Distort Due to Liking/Loving or Disliking/Hating
Based on past association, stereotyping, ideology, genetic influence, or direct experience, humans have a tendency to distort their thinking in favor of people or things that they like and against people or things they dislike. This tendency leads to overrating the things we like and underrating or broadly categorizing things we dislike, often missing crucial nuances in the process.
Anyone who has been alive long enough realizes that, as the saying goes, “denial is not just a river in Africa.” This is powerfully demonstrated in situations like war or drug abuse, where denial has powerful destructive effects but allows for behavioral inertia. Denying reality can be a coping mechanism, a survival mechanism, or a purposeful tactic.
7. Availability Heuristic
One of the most useful findings of modern psychology is what Daniel Kahneman calls the Availability Bias or Heuristic: We tend to most easily recall what is salient, important, frequent, and recent. The brain has its own energy-saving and inertial tendencies that we have little control over – the availability heuristic is likely one of them. Having a truly comprehensive memory would be debilitating. Some sub-examples of the availability heuristic include the Anchoring and Sunk Cost Tendencies.
8. Representativeness Heuristic
The three major psychological findings that fall under Representativeness, also defined by Kahneman and his partner Tversky, are:
a. Failure to Account for Base Rates
An unconscious failure to look at past odds in determining current or future behavior.
b. Tendency to Stereotype
The tendency to broadly generalize and categorize rather than look for specific nuance. Like availability, this is generally a necessary trait for energy-saving in the brain.
c. Failure to See False Conjunctions
Most famously demonstrated by the Linda Test, the same two psychologists showed that students chose more vividly described individuals as more likely to fit into a predefined category than individuals with broader, more inclusive, but less vivid descriptions, even if the vivid example was a mere subset of the more inclusive set. These specific examples are seen as more representative of the category than those with the broader but vaguer descriptions, in violation of logic and probability.
9. Social Proof (Safety in Numbers)
Human beings are one of many social species, along with bees, ants, and chimps, among many more. We have a DNA-level instinct to seek safety in numbers and will look for social guidance of our behavior. This instinct creates a cohesive sense of cooperation and culture which would not otherwise be possible but also leads us to do foolish things if our group is doing them as well.
10. Narrative Instinct
Human beings have been appropriately called “the storytelling animal” because of our instinct to construct and seek meaning in narrative. It’s likely that long before we developed the ability to write or to create objects, we were telling stories and thinking in stories. Nearly all social organizations, from religious institutions to corporations to nation-states, run on constructions of the narrative instinct.
11. Curiosity Instinct
We like to call other species curious, but we are the most curious of all, an instinct which led us out of the savanna and led us to learn a great deal about the world around us, using that information to create the world in our collective minds. The curiosity instinct leads to unique human behavior and forms of organization like the scientific enterprise. Even before there were direct incentives to innovate, humans innovated out of curiosity.
12. Language Instinct
The psychologist Steven Pinker calls our DNA-level instinct to learn grammatically constructed language the Language Instinct. The idea that grammatical language is not a simple cultural artifact was first popularized by the linguist Noam Chomsky. As we saw with the narrative instinct, we use these instincts to create shared stories, as well as to gossip, solve problems, and fight, among other things. Grammatically ordered language theoretically carries infinite varying meaning.
13. First-Conclusion Bias
As Charlie Munger famously pointed out, the mind works a bit like a sperm and egg: the first idea gets in and then the mind shuts. Like many other tendencies, this is probably an energy-saving device. Our tendency to settle on first conclusions leads us to accept many erroneous results and cease asking questions; it can be countered with some simple and useful mental routines.
14. Tendency to Overgeneralize from Small Samples
It’s important for human beings to generalize; we need not see every instance to understand the general rule, and this works to our advantage. With generalizing, however, comes a subset of errors when we forget about the Law of Large Numbers and act as if it does not exist. We take a small number of instances and create a general category, even if we have no statistically sound basis for the conclusion.
15. Relative Satisfaction/Misery Tendencies
The envy tendency is probably the most obvious manifestation of the relative satisfaction tendency, but nearly all studies of human happiness show that it is related to the state of the person relative to either their past or their peers, not absolute. These relative tendencies cause us great misery or happiness in a very wide variety of objectively different situations and make us poor predictors of our own behavior and feelings.
16. Commitment & Consistency Bias
As psychologists have frequently and famously demonstrated, humans are subject to a bias towards keeping their prior commitments and staying consistent with our prior selves when possible. This trait is necessary for social cohesion: people who often change their conclusions and habits are often distrusted. Yet our bias towards staying consistent can become, as one wag put it, a “hobgoblin of foolish minds” – when it is combined with the first-conclusion bias, we end up landing on poor answers and standing pat in the face of great evidence.
17. Hindsight Bias
Once we know the outcome, it’s nearly impossible to turn back the clock mentally. Our narrative instinct leads us to reason that we knew it all along (whatever “it” is), when in fact we are often simply reasoning post-hoc with information not available to us before the event. The hindsight bias explains why it’s wise to keep a journal of important decisions for an unaltered record and to re-examine our beliefs when we convince ourselves that we knew it all along.
18. Sensitivity to Fairness
Justice runs deep in our veins. In another illustration of our relative sense of well-being, we are careful arbiters of what is fair. Violations of fairness can be considered grounds for reciprocal action, or at least distrust. Yet fairness itself seems to be a moving target. What is seen as fair and just in one time and place may not be in another. Consider that slavery has been seen as perfectly natural and perfectly unnatural in alternating phases of human existence.
19. Tendency to Overestimate Consistency of Behavior (Fundamental Attribution Error)
We tend to over-ascribe the behavior of others to their innate traits rather than to situational factors, leading us to overestimate how consistent that behavior will be in the future. In such a situation, predicting behavior seems not very difficult. Of course, in practice this assumption is consistently demonstrated to be wrong, and we are consequently surprised when others do not act in accordance with the “innate” traits we’ve endowed them with.
20. Influence of Stress (Including Breaking Points)
Stress causes both mental and physiological responses and tends to amplify the other biases. Almost all human mental biases become worse in the face of stress as the body goes into a fight-or-flight response, relying purely on instinct without the emergency brake of Daniel Kahneman’s “System 2” type of reasoning. Stress causes hasty decisions, immediacy, and a fallback to habit, thus giving rise to the elite soldiers’ motto: “In the thick of battle, you will not rise to the level of your expectations, but fall to the level of your training.”
21. Survivorship Bias
A major problem with historiography – our interpretation of the past – is that history is famously written by the victors. We do not see what Nassim Taleb calls the “silent grave” – the lottery ticket holders who did not win. Thus, we over-attribute success to things done by the successful agent rather than to randomness or luck, and we often learn false lessons by exclusively studying victors without seeing all of the accompanying losers who acted in the same way but were not lucky enough to succeed.
22. Tendency to Want to Do Something (Fight/Flight, Intervention, Demonstration of Value, etc.)
We might term this Boredom Syndrome: Most humans have the tendency to need to act, even when their actions are not needed. We also tend to offer solutions even when we do not have knowledge to solve the problem.
23. Falsification / Confirmation Bias
What a man wishes, he also believes. Similarly, what we believe is what we choose to see. This is commonly referred to as the confirmation bias. It is a deeply ingrained mental habit, both energy-conserving and comfortable, to look for confirmations of long-held wisdom rather than violations. Yet the scientific process – including hypothesis generation, blind testing when needed, and objective statistical rigor – is designed to root out precisely the opposite, which is why it works so well when followed.
The modern scientific enterprise operates under the principle of falsification: A method is termed scientific if it can be stated in such a way that a certain defined result would cause it to be proved false. Pseudo-knowledge and pseudo-science operate and propagate by being unfalsifiable – as with astrology, we are unable to prove them either correct or incorrect because the conditions under which they would be shown false are never stated.
Column | Troubled ‘turbantor’ Harbhajan and his aggressive instincts
The retirement of Harbhajan Singh from all forms of competitive cricket in December 2021 brought to close the career of a gifted cricketer who courted controversy at every turn of his career. During the first years of the 21st century, he was arguably the best spin bowler in the world and though his wicket-taking abilities hit a plateau after that, he sustained himself by the versatility that saw him play all formats of the game at the highest level with reasonable success. He was a regular in the national side and part of the team that won the International Cricket Council (ICC) T20 World Cup in 2007 and the ICC World Cup in 2011. Though he lost his place in the national squad in 2015, he continued playing in Indian Premier League (IPL) till he chose to hang up his playing boots last month.
Harbhajan kickstarted his career during the 1997-98 season when he found himself playing for the national side in March 1998 within four months after making his debut for Punjab in Ranji Trophy. His performances at the junior level and the absence of top quality off-spin bowlers were factors that prompted the selectors to try out this rookie bowler, then still in his teens. He did not set Kaveri on fire on his Test debut, which took place against Australia at Bangalore. Within one month, he made his bow in One Day Internationals (ODIs) as well but a string of below-par performances saw him lose his place in the side soon thereafter.
After going through a period of near oblivion when he was also thrown out of a training programme in National Cricket Academy on charges of indiscipline, Harbhajan staged a comeback to the national side in the winter of 2000-2001 with a performance that will be remembered by followers of the game in India for all times. Australia, led by Steve Waugh, had landed in India to conquer the “final frontier”. The visitors were on a high, having won the previous 15 matches on the trot and looked forward to creating a new world record with 17 consecutive triumphs in Tests, while also winning the series. And when they won the first Test at Mumbai by a margin of 10 wickets, everyone thought that they were on their way to attaining both their goals.
The Kolkata Test against Australia in February 2001 is known as “Laxman’s Test”, for his knock of 281 runs in the second innings which helped India to script a magnificent turnaround and win this game, after trailing in the first innings by 274 runs. Harbhajan also had a crucial role to play in this victory as he took 13 wickets (7 for 123 in first innings and 6 for 73 in the second), including a hat-trick on the first day. In the last Test at Chennai, Harbhajan again played a stellar role, bagging 15 wickets for 217 runs (7 for 133 in first and 8 for 84 in second innings) to finish the series with a tally of 32 wickets. Aussie batsmen did not have any answer for his wiles and even such accomplished performers as Rickey Ponting and Adam Gilchrist appeared shell-shocked while facing him. Australian media nicknamed him as “Turbanator”- a tribute to his destructive capacity with the ball.
Harbhajan’s career did not ever attain the stratospheric heights that this performance promised. The surfeit of limited overs’ cricket made him focus more on restricting runs than on “buying” wickets. This resulted in bowling a flatter line without “giving the ball air”; the classic loop which is the hallmark of a top-class off-spinner also disappeared. This made him a less destructive bowler except on helpful surfaces and the returns also started growing thinner. When Anil Kumble returned to the side after recovering from an injury, Harbhajan moved into the slot of support spin bowler.
A finger injury caused Harbhajan to return home during the tour to Australia in 2003-04. He returned to the side the next season and was amongst wickets with most of the games being played at home. However, the arrival of Greg Chappell as coach and the exit of Sourav Ganguly as captain of the national side in 2005 caused hiccups in Harbhajan’s career. He was the first Indian cricketer to publicly criticise Chappell and his methods and said that the coach was “instilling fear and insecurity” in the side. Though his explanation was called for, Harbhajan managed to escape action and issued a statement lauding Chappell soon thereafter!
Harbhajan found himself in the midst of one of the biggest controversies in cricket when India toured Australia in 2007-08. In the second Test at Adelaide, Australia lodged a formal complaint that he indulged in racial abuse against Andrew Symonds. The relations between the two sides were at a low ebb and this incident even threatened to disrupt the conduct of the remaining part of the tour. Harbhajan vehemently denied the charges and the Indian team management supported him. But Mike Proctor, the match referee, found him guilty and slapped a punishment. India promptly appealed against this verdict and got a stay, which allowed the tour to go on. Eventually, the ICC appeals Commissioner Justice John Hansen overturned the verdict of the match referee and absolved Harbhajan.
Controversy continued to dog Harbhajan even after the closure of this episode. During the Indian Premier League (IPL) matches in 2008, he slapped fellow India teammate S Sreesanth after the game between Kings XI Punjab and Mumbai Indians, which the latter side, led by Harbhajan, lost. The slapping of a national player in full view of television cameras drew widespread criticism and Board of Control for Cricket in India (BCCI) moved fast and initiated action against Harbhajan.
Incidentally, this was not the first time that Harbhajan had got physical with Sreesanth. During the Champions Cup trophy match in 2007, he had shoulder charged the fast bowler when he was walking to the top of his bowling mark. BCCI had chosen to ignore this incident despite it being witnessed across the country. But the “slapgate” was too serious to be brushed under the carpet and Harbhajan was barred from playing the remaining matches of that season of IPL, besides a five-match suspension from ODI’s.
Harbhajan’s international career took a severe reverse when he was injured during the tour to England in 2011. He was not selected for the tour to Australia in 2011-12 and his appearances in international matches became sporadic after that. He played his last Test in August 2015 and his final appearance in an ODI took place two months later, though he continued to play domestic first-class cricket till 2017. Since then, his appearances on the cricket field were limited to playing in IPL, where he picked up 150 wickets in 13 editions.
A tally of 417 wickets in Tests and 269 scalps in ODI’s makes Harbhajan the second most successful off-spinner to play for India, after Ravichandran Ashwin. He could also wield the willow effectively as evident from a total of 2,224 runs in Tests with 2 centuries and 9 fifties. He was also the first spin bowler from India to adjust to the demands of all versions of cricket effectively. But his tendency to create controversies and lack of amenability to discipline cast a cloud over his career which could have reached much greater heights given the prodigious talent he was blessed with.
Followers of the game from Kerala could be forgiven for not harbouring a soft spot towards this highly competitive cricketer as he is considered to be the bugbear of Sreesanth and the source of all troubles that the Kochi born pacer found himself in. News reports indicate that the two cricketers subsequently spoke to each other and resolved their differences. But it would be difficult for the fans to forgive so easily as the bad taste created by those incidents does not vanish quickly. The same is the case with cricketers and cricket-loving public of Australia, as could be understood from the observations in the autobiography of Gilchrist, despite Harbhajan and Symonds sharing the same dugout in IPL.
In retrospect, one is forced to conclude that it would have been better for Indian cricket if the aggressive instincts of Harbhajan Singh were channelled properly on the cricket field and outside.
(The author is a former international umpire and a senior bureaucrat)
Sports Betting’s Next Big Election Battles Are in California
TEMECULA, Calif. — Legal sports betting in the United States accelerated in 2021 as a flurry of states either overcame legislative logjams, as Ohio did just before Christmas, or signed off on online wagering, as New York did just after Election Day.
But those efforts are likely to pale in comparison to the all-out lobbying, campaigning and legal jousting in 2022 involving what a DraftKings executive recently called “one of the holy grails” in sports betting: California.
By November, Californians may be asked to vote on as many as four sports betting initiatives. That’s why deep-pocketed interests, including national sports books and Native American casinos, have been gearing up to spend $200 million to persuade voters in California to support their particular proposal — or to reject the others.
One measure that has already qualified for the state ballot, sponsored by powerful tribes in California, would add sports wagering, but only in person, at tribal casinos or horse racing tracks. Online betting initiatives, now gathering signatures, dangle the prospect of making bets anywhere through the internet. Others offer a middle ground.
If one of the measures passes, nearly two-thirds of Americans will live in states that allow or regulate sports betting. And with California and New York on board, sports wagering would essentially be national in scope, fueling a market that Goldman Sachs recently estimated could grow to $40 billion in revenues in a decade from $900 million now.
Yet gambling expansion in California has often fallen short or been torpedoed by competing interests. Indeed, California’s card rooms, which primarily operate around larger cities and offer a more limited range of games, just filed a lawsuit to invalidate the qualified tribal measure.
“We’re never going to get sports betting figured out at any level unless California comes on board,” Jason Giles, executive director of the National Indian Gaming Association, said at a recent sports betting conference at the Pechanga Resort and Casino in Temecula. “That will be the game changer for the United States.”
Since the Supreme Court’s decision in 2018 to strike down a federal law banning commercial sports betting in states other than Nevada, more than 30 states have authorized sports wagering, including about a dozen in the last year. More than 20 states have gone live.
New York just started mobile sports betting after awarding licenses for it to two coalitions featuring marquee names, Caesars Sportsbook and Bally’s Interactive. Gov. Mike DeWine of Ohio signed a bill legalizing sports betting in late December. And legislators in Wyoming and Arizona, among others, quickly approved sports betting.
“Look at this massive expansion across the country and where we are — it’s becoming very mainstream,” said Brandt Iden, a former state representative in Michigan who pushed to legalize sports betting in his home state. Iden is now head of government affairs for Sportradar, which collects and analyzes data for sports books. “I talk to legislators who say, you know what, I don’t support gambling, but everybody is doing it.”
Of the holdouts, Texas considered several bills in 2021, and some lawmakers expect momentum when the legislature reconvenes in 2023. Florida, meanwhile, is a mess: A federal judge recently blocked the Seminole Tribe’s new sports betting app, and DraftKings and FanDuel are racing to gather enough signatures to get a referendum on the 2022 ballot.
In California, gambling — mostly on slot machines and blackjack — has been legal for two decades on tribal lands under compacts negotiated with the state. The state also permits gambling at horse racing tracks, which was legalized in 1933, and card rooms, which trace their lineage to poker-playing miners during the Gold Rush.
Any changes would require constitutional amendments through a voter referendum, or legislation backed by the voters.
Previous attempts have bogged down; online poker, for instance, failed in part because the tribes themselves were split. But now there appears to be less resistance on moral and philosophical grounds.
“If we think about progressive legislation, or legislation to protect consumer welfare, California lies at the forefront, whether we want to talk about minimum wage or privacy protection,” said Marc Edelman, a law professor at Baruch College who has written extensively on sports gambling. “If California legalizes sports gambling it becomes very unlikely that another state would arise as the consumer-oriented opposer of sports gambling.”
This time, the push to expand gambling began before the pandemic, from a coalition of 18 tribes that have dominated casino gambling in the state.
Across the United States, tribal gambling generated $27.8 billion in revenue in its fiscal year from Oct. 1, 2019, to Sept. 30, 2020, despite the pandemic. California is the biggest state, with 66 tribal casinos on federally recognized lands, mostly far from the coast, yielding about $8 billion, with much of that coming from slot machines.
Under the tribes’ initiative, which is backed by a political action committee that has raised more than $13 million, sports wagering would be permitted at tribal casinos and horse tracks. Roulette and games played with dice, such as craps, would also be allowed under the proposal, which qualified for the ballot in May 2021 after collecting more than one million valid signatures.
One thing that is not included is online betting, because the initiative is intended to be “a very measured, incremental step,” said Mark Macarro, tribal chairman of the Pechanga Band of Luiseño Indians in Riverside County.
“We think this is the right thing to do for tribes and tribal sovereignty,” he said at the conference here. “There’s enough skittishness out there about what could happen to brick-and-mortar facilities.”
The initiative would also create a new civil enforcement tool allowing anyone suspicious of any illegal gambling operations to file lawsuits. It is this provision that has fueled two separate but related efforts by California’s card rooms to defeat the tribes, and to get their own sports betting measure passed.
California has more than 80 card rooms ranging from pub-like places with a few poker tables to sleek behemoths with 270 tables accompanied by restaurants and plentiful A.T.M.s. Collectively, they employ 23,000 people in urban areas, many of them Asian, Black and Hispanic, and pump in $300 million in federal, state and local tax revenues each year, according to the California Gaming Association, a trade group.
Many municipal budgets rely heavily on the card rooms to finance vital services and bolster juvenile justice and other programs, said Mayor Tasha Cerda of Gardena, which has two card rooms. She has backed an initiative that would permit sports betting at the card rooms, tribal casinos and racetracks, as well as allow for internet sports betting. That initiative has raised $450,000 to date. Meanwhile, some of the bigger card rooms have poured more than $24 million into a “No” campaign against the tribes’ initiative.
During a recent tour of Hollywood Park Casino in Inglewood, adjacent to SoFi Stadium, the host of the Super Bowl next month and the College Football Playoff national championship in 2023, Deven Kumar, the casino’s general manager, estimated sports betting could increase revenues — already hurt by the coronavirus pandemic — by 20 percent to 25 percent. He and James T. Butts Jr., Inglewood’s mayor, warned that the tribes’ civil enforcement provision could drain their existing business by up to 75 percent, compounded by the inevitable legal costs.
“They are attempting to make gambling a monopoly at the expense of others,” Butts said. “They are not the disenfranchised group they once were. The minority majority cities deserve the opportunity for equity as well.”
In the city of Hawaiian Gardens, where the Gardens Casino supplied 68 percent of the tax revenues in the 2019-20 municipal budget, Keith A. Sharp, the casino’s general counsel, said sports betting could transform Sundays at the casino — now mostly empty — into bustling periods where customers could wager on N.F.L. games while also playing baccarat or other games.
If the card rooms were hobbled, however, Nary Chin, a longtime card dealer and single mother of four, said she feared for her future.
“I learned English in the card room, not school,” said an emotional Chin, who immigrated from Cambodia in 1984. “I am very grateful. This is my home. If I didn’t have this job, I don’t know what I’d do.”
The third initiative comes from online sports books, including DraftKings and FanDuel, that want to enter California for the first time and offer online betting.
The measure requires those companies to partner with tribes, and its supporters say voters can pass both their initiative and the tribes’ in-person one. Most of the state’s profits would be dedicated to homelessness measures, and to the tribes themselves. It would also allow betting on nonathletic events, like award shows and video game contests, but not youth sports or elections, according to the nonpartisan Legislative Analyst’s Office.
“We view brick-and-mortar as very complementary to mobile,” Jonathan Edson, FanDuel’s senior vice president for business development, said at the sports betting conference.
“California is one of the holy grails in sports,” added Jeremy Elbaum, senior vice president for business development at DraftKings.
The supporters, buffeted by an initial $100 million from seven sports books, have lined up mayors in Long Beach, Oakland, Fresno and Sacramento, plus advocates working to combat a homeless crisis. They are confident they will collect enough signatures to be certified by the June ballot deadline.
“We are focused on ongoing stable revenue to fund the key programs that we know we need,” said Tommy Newman, vice president for engagement and activation at the United Way of Greater Los Angeles. “If we’re honest, this is regulating and capturing value from something that is happening, for people in communities that absolutely need the investment.”
In November, a fourth initiative arrived supporting both online and in-person betting, backed by a different group of tribes, including the Rincon Band of Luiseño Indians and the San Manuel Band of Mission Indians.
“Out-of-state and international gaming operators want to rewrite the balanced system California has created so that the future belongs to them, paying a pittance to serious local and statewide social problems, and trying to divide the Tribes by offering temporary riches to a few while taking future growth opportunities away from the rest,” the tribes wrote in their application to the California attorney general.
A lawyer for the tribes, Scott Crowell, did not respond to messages seeking comment.
Some gambling analysts believe that a plethora of initiatives may confuse voters, who may just say no to everything. Another wild card is a lawsuit filed in December by two card rooms claiming that the qualified tribal initiative violates the state constitution, which says initiatives can focus only on one subject, because the tribes are trying to add retail sports betting as well as add more table games.
Still, no matter the outcome of the lawsuit or the ballot measures, many sports and technology companies are building audiences through free-to-play games, contests, fantasy sports and national marketing campaigns, even in states where sports betting has not yet been cleared, said Rob Phythian, founder and chief executive of SharpLink Gaming, a technology company.
Teams like the Minnesota Vikings have hired companies like SharpLink to build fantasy games. That could be consequential in California, where there are 19 teams in the N.F.L., M.L.B., N.B.A., N.H.L. and W.N.B.A. — by far the most of any state.
“We’re just a bridge to betting,” Phythian said. “It’s sort of like training the muscle.”
Addressing maternal health inequities | AAMC
Kysha Shaw lives with a lot of uncertainty. Among other things, the 42-year-old single mother of three worries about COVID-19, schools closing, and drug use and crime in her West Baltimore neighborhood.
“I love this community, but it can be really sad,” she says. “You see people begging for shoes and clothes. You might see someone slumped over with a needle in their arm. People sell drugs in front of the convenience stores.”
But Shaw is determined to keep herself and her children healthy, which she’s done thanks in part to an innovative effort called B’more for Healthy Babies Upton/Druid Heights (BHB U/DH). Founded in 2011, the program is part of a citywide initiative and is a partnership between the local community, the University of Maryland Medical Center, and the University of Maryland, Baltimore.
BHB-U/DH supports mothers and babies in West Baltimore, where 92% of residents are Black and 66% of children live below the federal poverty level. It provides prenatal education, support groups, smoking cessation, some rental assistance, and connection to a range of social services. Among other achievements, the effort has reduced infant mortality by 75%.
Experts believe that programs like BHB U/DH are essential if the United States hopes to address the inequities in maternal health found in so many crowded cities and remote rural towns.
The statistics are striking: Black and American Indian/Alaskan Native women are two to three times more likely to die from pregnancy-related causes than White women. Black women are twice as likely to experience serious perinatal complications. And early indicators suggest that COVID-19 is only exacerbating such inequities.
What’s more, advanced degrees and full bank accounts don’t close the gap. In fact, a college-educated Black woman faces a 60% greater risk of maternal death than a White woman with no high school diploma. Why is that? Experts point to the effects of subtle and explicit racism as well as weathering, the biological fallout of ongoing stress that can cause premature aging and related health problems.
Faced with this worrisome reality, researchers and providers are working to improve the health of vulnerable pregnant people before, during, and after childbirth.
“It’s incredible, some of the things I’ve heard our moms go through when they’re seeking care. It’s heartbreaking.”
Kamilah Dixon-Shambley, MD
Medical director of Moms2B
“Inequities are so pervasive and persistent that they require multisector efforts,” says AAMC Health Equity Research Analyst Funmi Makinde, MPH. “We need to address transportation, employment, and housing as well as physician shortages, and we need more diverse providers. We need high-quality data that are shared publicly to ensure accountability. The list goes on.”
Throughout all this work, it’s crucial to include the perspectives of patients who are often overlooked, experts say. In one recent survey, 20% of Black, biracial, and Latinx people felt their medical requests were refused or ignored, compared with 11% of White people.
“It’s incredible, some of the things I’ve heard our moms go through when they’re seeking care. It’s heartbreaking,” says Kamilah Dixon-Shambley, MD, medical director of Moms2B, an Ohio State University Wexner Medical Center program that provides yearlong supports and health education to low-income new and expectant mothers. “It’s crucial that patients and the community can trust their providers.”
Below, AAMCNews profiles multifaceted efforts to address maternal health inequities across the country.
Data that save lives
In 2006, California officials noted a worrisome trend: Maternal mortality was on the rise, even as the state recorded the most births nationwide.
Hoping to reverse the disturbing death rate, they turned to Stanford University School of Medicine to co-found the multistakeholder group that became the California Maternal Quality Care Collaborative (CMQCC).
Serious number-crunching has fueled much of the CMQCC’s work. For one, it collects and analyzes hospitals’ raw data to quickly identify areas ripe for improvement, including racial and ethnic disparities.
“We send hospitals back reports, and they are flabbergasted when data are broken down by race and ethnicity. They may see that their Black patients have 6 percentage points higher C-section rates than Whites,” says CMQCC Medical Director Elliott Main, MD. “That really spurs them on to look at addressing racism in labor and delivery.”
CMQCC experts also use data to identify the need for and then create step-by-step provider toolkits on key causes of birth-related complications. One on postpartum hemorrhage, which covers such crucial moves as measuring and effectively treating blood loss, reduced disparities between Black and White patients by nearly 80%.
“The standardized protocols in toolkits take away a lot of provider subjectivity,” Main says. “Subjectivity is the entrée for biases that impact patient care.”
And hospitals in the collaborative — there are more than 200 of them — can receive training on implementing the toolkits. “A toolkit that sits on the shelf does nothing,” he adds.
“We send hospitals back reports, and they are flabbergasted when data are broken down by race and ethnicity. … That really spurs them on to look at addressing racism in labor and delivery.”
Elliott Main, MD
Medical director of the California Maternal Quality Care Collaborative
All of these efforts have borne fruit: Since the launch of the collaborative, California’s maternal deaths have dropped by 65%.
Now, the CMQCC is crafting additional equity-related recommendations, such as handing expectant patients a staff-signed commitment promising to treat every patient with dignity and engage them in all birth-related decisions.
Also high on the CMQCC agenda is assessing the approaches of maternal mortality review committees, the bodies that study every pregnancy-related death.
“Often a problem is that review materials are medical-centric, and obviously the patient can’t tell her own story,” says Main. “We’re now exploring interviewing family members who lost a relative for their perspective. I think that’s going to be the future of committee reviews.”
Pregnancy always brings some stress, but the tension is much higher for patients who struggle to understand English and the intricacies of the U.S. health care system.
That’s why Crista Johnson-Agbakwu, MD, founded Valleywise Health’s Refugee Women’s Health Clinic in Arizona in 2008.
Since then, the Phoenix-based center has served more than 16,000 patients, many from countries across Africa. Arizona, which ranks high on the list of states resettling refugees, is now integrating evacuees from Afghanistan, says Johnson-Agbakwu.
“These are people who have escaped war and gender-based violence and other human rights atrocities,” she notes. “It’s important to understand the communities’ needs and meet the priorities they identify.”
To help do that, the clinic hires cultural health navigators (CHNs) — lay health care workers steeped in the culture and language of those they serve. “CHNs deeply understand patients’ background, religion, and lived experience and can interpret their health care through those lenses.”
CHNs offer patients ongoing supports, from accompanying them to prenatal visits to facilitating a smooth hospital discharge. And they can chart all interactions in electronic health records so that physicians know what’s been done or discussed.
“These are people who have escaped war and gender-based violence and other human rights atrocities. It’s important to understand the communities’ needs.”
Crista Johnson-Agbakwu, MD
Founder of Valleywise Health’s Refugee Women’s Health Clinic
Like Baltimore’s BHB, Ohio’s Moms2B, and similar programs, the clinic’s supports are accompanied by classes on perinatal health. But its offerings include a tour of the hospital labor and delivery unit — a crucial support for participants unaccustomed to Western, medicalized births.
“Things like IV lines and beeping noises and blood pressure cuffs can be very scary for this population,” says Johnson-Agbakwu. “They’re used to being mobile in labor and can interpret what we do as tying them to the bed. The tour helps demystify a lot of this.”
In all its work, the clinic strives to honor patients’ perspectives. “We try to go beyond checking the boxes of ensuring medical care,” she says. “We are engaging in care that’s anchored in mutual respect. That’s a piece that can be missing in achieving maternal health equity.”
Reaching rural patients
Many of the patients treated by Vidant Health in eastern North Carolina face significant pregnancy-related risks. More than half are overweight or obese, and many have diabetes or hypertension. The poverty rate of this population is twice the national average, and nearly all live in remote rural areas.
Black people — who comprise roughly a third of Vidant’s birthing patients — often fare the worst. In one recent nine-year period, they represented nearly 70% of maternal deaths in the region.
And Vidant Medical Center, based in Greenville, is the only large hospital in an expanse covering 29 counties.
Since 2017, Vidant has been working to support providers throughout the region in efforts to ensure high-quality care during obstetrical emergencies.
One major focus is drills in birth-related crises. These simulations — hundreds have been held in 18 hospitals over the past three years — cover emergency cesarean sections, maternal resuscitation, and more.
The scenarios unfold realistically: A Vidant staff member assumes the role of a patient, and the local team races to save her — calling for emergency assistance, rushing to get instruments, and suggesting necessary maneuvers.
“In a small hospital, these emergencies happen maybe once every two or three years,” which makes it tough to keep skills fresh, says James deVente, MD, PhD, medical director of obstetrics at Vidant Medical Center. “We give them a chance to practice skills over and over so that when something actually happens, they’re ready.”
Traveling to provide training is not always the best option, though. So Vidant providers have also logged thousands of hours advising local providers on how to handle their toughest perinatal cases.
Now, in an effort launched in July 2020, Vidant experts also remotely treat high-risk patients, working in collaboration with 15 local obstetricians.
“Patients often need to drive 60 miles or more each way to be seen [at Vidant],” says Alan Sacks, MD, who heads the Maternal Outreach Through Telehealth for Rural Sites (MOTHeRS) Project. “Appointments can be a costly ordeal in wages lost for a day off from work, child care, and transportation. The project is patient-centered. We basically go to them.”
In addition to telehealth services like remote ultrasound, the effort screens all participants for food insecurity. Those in need immediately receive a food package and are connected to a local food bank. All patients with diabetes or obesity also receive ongoing nutrition counseling.
Sacks highlights another key component of the program: mental health care.
“Mental health disorders carry a 50% increase in severe maternal morbidity and mortality. Nearly 9% of maternal deaths are attributable to mental health disorders. All of these figures are higher in African American patients. The situation and statistics are tragic and can fuel a worrisome intergenerational cycle.”
Looking ahead, Sacks hopes to expand the MOTHeRS Project to additional remote locations. Meanwhile, Vidant’s efforts so far have made a difference. For example, the infant mortality rate in the region dropped by 24% in recent years.
“There’s more work to be done,” says deVente. “But we set out to make this region a better place to give birth and be born, and I think we’ve succeeded in doing that.”
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